It's no secret that many doctors get paid by pharmaceutical companies to talk to other docs—about general conditions, research trends or specific drugs—or to provide expertise for company research. But what has long been undisclosed is the amount of money that these drugmakers were giving physicians for their time.

Thanks in part to some high-profile U.S. federal court settlements, some of that information has started to come into public view. But because payment information has been reported differently by different companies, it's been hard to glean a clear sense of just how much money many of these doctors were making. Although figures on prescription patterns are difficult to obtain, many worry that money, meals and trips from pharmaceutical companies could bias doctors' prescribing habits.

A new "Dollars for Docs" database, assembled in part by the investigative journalism organization ProPublica, now allows people to look up the names of their health provider to see how much they might have collected recently from some of the major pharmaceutical companies—a figure that might have been unclear even to the doctors themselves, Tracy Weber, a ProPublica reporter who worked on the project, said in a conference call on Thursday.

In all, the data cover some $257.8 million dollars in pharma payments to doctors made since the beginning of 2009.

The totals in the database, however, are not the full picture. In fact, only seven of the dozens of drug-makers that give speaking awards and other honoraria to doctors, have made their payments public. The companies included in the database (AstraZeneca, Cephalon, GlaxoSmithKline, Johnson & Johnson, Lilly, Merck and Pfizer) make up a little more than a third of all prescription drug sales in the U.S. in 2009, Charles Ornstein, a ProPublica senior reporter and collaborator on the project, noted during the call.

And, Weber said, as court documents have made clear, drug companies seem to have firm control over the content of drug company-funded talks—providing presentation slides and scripts that often at least mention a company's drugs. Some doctors were paid handsomely for speaking to an audience of one, and others were paid to be trained by a company that had no intention of sending them out to talk. ProPublica's report also revealed that many of the doctors who were backed with pharma money lacked proper specialist credentials for the field they were discussing or were even under investigation for medical or other misconduct.

ProPublica plans to update the database as more figures become available in the future. But with the inclusion of the Physician Payment Sunshine Act in the recent healthcare overhaul, all payments to doctors from pharma companies will be required to be made public by 2013. "That will make our database obsolete," Ornstein said. "We welcome that."

It makes you wonder how many unnecessary drugs were prescribed just to keep the gravy train running.

Fortunately with "Obamacare" these kickbacks will become public information.

Frankly, I think the drug companies should offer sexual favors and money for writing prescriptions, at least it's more honest and less manipulative.

Oh yes, and you'll be happy to note that something like up to 80% of the research that goes into those medical journals and drug company reports is wrong.

His model predicted, in different fields of medical research, rates of wrongness roughly corresponding to the observed rates at which findings were later convincingly refuted: 80 percent of non-randomized studies (by far the most common type) turn out to be wrong, as do 25 percent of supposedly gold-standard randomized trials, and as much as 10 percent of the platinum-standard large randomized trials. The article spelled out his belief that researchers were frequently manipulating data analyses, chasing career-advancing findings rather than good science, and even using the peer-review process—in which journals ask researchers to help decide which studies to publish—to suppress opposing views. “You can question some of the details of John’s calculations, but it’s hard to argue that the essential ideas aren’t absolutely correct,” says Doug Altman, an Oxford University researcher who directs the Centre for Statistics in Medicine.

But, yeah, I don't trust doctors who get paid to preach the merits of whichever pharmaceutical currently is giving their entire staff luncheons twice a week.

Last November, I had a bout of gastritis and listened to the GI doctor, followed his instructions, took the standard course of Aciphex plus Carafate (When your stomach is on fire and preventing sleep, you'll try just about anything)

However when the standard course was done, I then discovered not-standard side effects that can occur after said standard course is complete. Hint:After the wonder PPI turns off the acid pumps in your stomach, the endocrine system overproduces chemical signals designed to tell the stomach to make more acid pumps. To wit, going off of the darlings of the Big Pharma is not a pleasant experience.

After a trip to the ER, and trying to get off the stronger PPIs with OTC products such as Pepcid, and being unsuccessful for months, I decided to stop taking the acid blockers and start taking things that would heal the stomach, and strengthen the LES (lower esophageal sphincter)

What worked for me is a brand of Manuka Honey that has been certified UMF 16-19. Together with Mastic Gum (3,500 year old Mediterranean remedy for stomach issues) they resolved both my original problem and my side effects from the acid-blockers within 8 weeks. I have not had any problems since then, thank God.

I wonder why my doctor never mentioned my problem might be resolved with a specific honey and tree resin?

And to preliminarily answer Fyyr's question.. both are synthetic compounds, Liptor(atorvastatin) is twice as potent as Zocor(simvastatin), I believe Zocor has the greater risk of rhabdomyolysis. To me it matters not, because neither one would I put in my body due to the many other side effects. If I just absolutely had to take a statin, I'd make sure to load up on a daily dose of 150mg of CoQ10, and only take Mevastatin (it is derived from red yeast rice and/or oyster mushrooms, naturally occurring substances)

Writing is the clothing of the Internet. If you choose to appear as a bum, reeking of urine and booze, that is up to you.

But, yeah, I don't trust doctors who get paid to preach the merits of whichever pharmaceutical currently is giving their entire staff luncheons twice a week.

It isn't that the doctors are to blame, per se, they're being horribly manipulated using clever psychological tactics. Listen to that NPR piece, I linked.

Everyone assumes they're immune to that sort of thing but I betcha almost no one is if they're unaware of it.

The Role Of The 'Thought Leader'

According to Webb and Maher, Clawson's view that speaking is educational is not at all accidental. Drug companies train representatives to approach a narrow set of doctors in a very specific way, using language that deliberately fosters this idea that the doctors who speak are educators, and not just educators, but the smartest of the smart.

For example, every drug representative interviewed for this story used the exact same phrase when approaching a doctor with a pitch to become a speaker: Each doctor approached to speak was told that he was being recruited to serve as a "thought leader."

This phrase, Webb says, seems to have incredible psychological power.

"When you do say 'thought leader' I think it's a huge ego boost for the physicians," Webb says. "It's like a feather in their cap. They get a lot from it."

This is because most doctors have a very specific idea in mind when you ask them what constitutes a thought leader. Most doctors, including Clawson, cite two important qualifications. "First, the other doctors in the community respect that person's opinion," Clawson says. "And the other way to become a 'thought leader' is to become an academic researcher and try to push the bounds of science further, and then by definition you're a thought leader."

But some drug representatives, like Maher, have a more cynical view of why drug companies choose the doctors they choose. It's not about how well respected the doctor is, according to Maher; it's about how many prescriptions he writes.

"I think nowadays a thought leader is defined as a physician with a large patient population who can write a lot of pharmaceutical drugs. Period," she says.

Do the doctors who do the speaking know that their prescribing habits have changed? If they do know, then in a sense they're being bought. If they don't, then they're unwittingly being played.

This doesn't mean that every doctor recruited is not a high-quality doctor. Many are. But every representative NPR spoke to had a stable of stories about profoundly unimpressive doctors that they'd recruited as thought leaders essentially for the same reason that a robber robs a bank: because that's where the money is.

The fact is that the top 20 doctors in a representative's territory prescribe the vast majority of the medication. According to Webb, the top 20 percent prescribe as much as the lower 80.

So if you want to sell more of your product, and every representative is required to sell more, those are the physicians to target.

Which brings us to the hard reality about doctor speaking: Although doctors believe that they are recruited to speak in order to persuade a room of their peers to consider a drug, one of the primary targets of speaking, if not the primary target, is the speaker himself.

That's where reps look for a real increase in prescriptions — after a speech.

Just after that, they show how they calculated how much more of a drug a doctor prescribes once they've flattered him and gotten him to speak. They figure the return for a 1,500 speaking fee is about 100,000. It isn't the people the doctor is speaking to, it's the doctor himself!

Zute wrote:Just after that, they show how they calculated how much more of a drug a doctor prescribes once they've flattered him and gotten him to speak. They figure the return for a 1,500 speaking fee is about 100,000. It isn't the people the doctor is speaking to, it's the doctor himself!

Hard to beat that ROI. If I were the rep I'd demand a bigger piece of the pie.

If I walk into a doctor's office with high cholesterol, I'm likely to walk out with some statin prescription.

Well, maybe, if you were non compliant with a low fat diet. Laypeople know that a doctor telling them to lose weight is a fucking joke. Docs still go through the motion(even though they know its a joke too). Many docs do prescribe prophylactically, not for your disease, but to protect themselves from your lawyer. You will need to fix that problem first; which is doubtful, our society loves suing people to get rich quick.

Even though you've admitted yourself that according to biased industry studies, the effect on cholesterol lowering is marginal, with the secondary effect on heart disease even more dubious.

No I didn't. I did not say or write that. At all. You are completely wrong.

Even though there are much simpler and far more effective methods of preventing heart disease.

More effective, yes. Simpler, no.

And you have to remember that healthy people die of heart attacks(AMIs) too. Much more than you realize.

I wonder, could it have something to do with the enormous profits drug companies make on these top-selling drugs?

Those are both generic drugs. They are out of patent. You could make them at no profit if you want to, Tudamorf.

How come you are not making them at no profit, Tudamorf. And giving them to us. Why are you so greedy?
I am amazed at your self absorbed liberal avarice. Hypocrite, say one thing, but do another.

Fyyr wrote:Laypeople know that a doctor telling them to lose weight is a fucking joke. Docs still go through the motion(even though they know its a joke too).

Precisely. They just go through the motions because their real goal is to push the drugs.

Fyyr wrote:Those are both generic drugs. They are out of patent.

Which is why the industry keeps coming out with fresh new patents, and convinces the to switch to the new drugs and drop the ones that are no longer profitable. Even if the new ones aren't better, or particularly innovative (like making a timed release version of the same drug).